The principal investigator's career has emphasized patient oriented research in Oral Epidemiology ranging from evaluation of risk factors, to mechanistic studies evaluating pathways, to clinical trials. Her ongoing funded research focuses on the relationships between oral conditions, inflammatory markers, nutrition and specific cardiovascular diseases. She has expanded this work to include additional cardiovascular endpoints and pregnancy outcomes, and is starting to work in diabetes. The principal investigator plans to gain additional research skills by learning Molecular and Genetic Epidemiology, which would substantially enhance her research. The principal investigator co-directs the comprehensive T32 training grant titled "New England Oral Disease Epidemiology Training Program" which is run jointly across the Harvard School of Dental Medicine and Harvard School of Public Health. The K24 award will nicely complement the T32 by providing the protected time to enhance mentoring. The principal investigator has substantial experience in mentoring trainees at different stages including students in the DMD program, clinicians seeking a doctoral degree in Epidemiology, and junior clinical faculty. These activities have resulted in a NIH small grant and a K-award headed by her mentees, and 21 peer reviewed published manuscripts with her mentees. This midcareer investigator award will allow the principal investigator to spend more time in mentoring and retaining clinicians (dentists as well as some physicians) in Oral Epidemiology research, and in helping them to become independent clinical researchers. There is a strong institutional commitment and a growing pool of clinicians seeking training and mentoring in Oral Epidemiology. The K24 will thus provide the much needed protected time and support at a critical time, which will enable her to build a strong research program in oral and systemic disease with an excellent team of patient oriented researchers, whom the principal investigator mentors. Candidate: Dr. Joshipura is an Associate Professor on Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine, and an Associate Professor in Epidemiology at the Harvard School of Public Health. She received a degree in dental surgery from Bombay University, India in 1982, a MS in Biostastics from the Harvard School of Public Health in 1982, and ScD in Epidemiology from the Harvard School of Dental Medicine and Harvard School of Public Health. She has an impressive list of publications in leading journals including JAMA, New England J Med, JNCI, Annals of Internal Medicine as well as the leading dental journals. She has an impressive track record of funded research in the area of chronic diseases, pregnancy outcomes, and periodontal disease. The candidate documented the ability to provide mentoring to beginning clinical investigators by listing 21 students to whom she has provided a mentoring role. Most, but not all, of these mentored individuals where dentists. The types of research have varied widely and include molecular epidemiology, periodontal disease and blood biomarkers, fluoride, cancer, obesity, and other topics. Her long-term career goal is built a research program in oral and systemic disease with a strong team of collaborators and mentees. There are enthusiastic letters of commitment from the Dean of Harvard School of Dental Medicine (Dr. Bruce Donoff) who provides a commitment that she will be able to spend at least 50% on patient-oriented research, a letter from Dr. Douglass who recommends her without qualifications, and Dr. Stampfer who similarly enthusiastically supports Dr. Joshipura and indicates the she plays a major role in the Oral Epidemiology training program. Research Plan: With respect to the currently supported research, Dr. Joshipura provides enough information in the areas of the hypotheses and the specific aims, background, significance and rationale, preliminary studies and results, research designs and methods. Her specific aims are to relate dental status to systemic disease, to determine the extent to which the systemic disease-dental status association is mediated by inflammatory and hemostatic mediators, and by intake of dietary fiber and antioxidants. Different cohorts in which these aims can be assessed are listed and the investigator has extensive familiarity with these cohorts as is exemplified by her publications. She provides as an example of one specific project where the association between periodontal disease and tooth loss was investigated. For this specific project she lists the specific aims, background, significance and rationale, preliminary studies and results, research designs and methods. It appears that no new research to be specifically supported by this grant is listed because Dr. Joshipura feels strongly that mentees should have the freedom to choose their thesis topics as well as additional projects to the extent feasible. Mentors: The availability of beginning clinician investigators for mentoring is described and includes T32 trainees. Individuals from underrepresented racial/ethnic groups will be specifically targeted for recruitment. The types of educational experiences the candidate will provide include selecting of appropriate course work, identification of a research project and a research mentor, guidance with respect to preparing for the written and oral qualifying exams, and make the trainee familiar with administrative policies and adherence to administrative guidelines. Environment and Institutional Commitment: The letters of support indicate a commitment to the scientific development of the candidate, an adequacy of research facilities, a provision of adequate protected time, and a commitment of the institution towards career development. Budget: No concerns